Prenatal Record - National Archives and Records Administration

INFECTIOUS DISEASE AND SYSTEM REVIEW
(For Form OB-7, Dated 1-59)
PURPOSE OF THIS FORM
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Study of the epidemiology of pregnancy wastage is made difficult
by the fact that important events or conditions may occur only
once in many thousands of pregnancies. Therefore, analysis .of
the relationship between supposed causes and the outcome of
pregnancy often must be based on relatively small numbers of
cases.
In such a situation, analysis is particularly vulnerable to the
haphazard introduction of cases having rare or obscure diseases
that are undiagnosed. For this reason scrupulous assessment of
the state of health of each gravida is a fundamental part of this
or any similar study.
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IN$IRUCTIONS FOR INTERVIEWER
The Infectious Disease and System Review, OB-7, is designed to
enable the interviewer and physician, working together, to
establish as complete a medical history as is possible within
the limits of this study. To do so requires careful and systematic
questioning of the patient. This may at times be a
burdensome task, but it will always be an important one. Poor
medical histories might render useless other very careful
observattons of the mother and child.
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At the top of page 1, record your first and last name and your
title or position, such as "Lay interviewer", "Nurse interviewer"
or "Social worker". Beneath this record the date on
which the history is taken, writing the month, day, and year
numerically, such as 6/22/59.
The review is divided into seventeen categories. The first three
of these are entirely to be done by the physician, so that you
should befin your interview with category #4, Respiratory System.
For each category you should attempt to discover all the
relevant aymptoms that the patient has experienced at any time
during her life. The questions listed are not necessarily all
the questions that you may need to ask, nor is the wording the
best for all patients. Make sure that the patient understands
the questio~s, before you accept a negative answer.
For those categories for which the patient gives a negative
history, write the figure
11
0 11 (zero) in the space reserved for
patient's comments, and make no other mark in the block. If
the patieot gives a positive history record in the space under
"Patient's COIIlments" all detail that will be helpful to the
physician. Ask about dates of onset and duration, and record
these. If the patient knows any diagnosis that may have been
made, record this also.
February 1959
(For Forms in Use April 1961)
Reproduced at the National Archives
II.A.l26
OB-7